Adjustable magnetic devices and methods of using same

ABSTRACT

A system includes a first pedicle screw, a second pedicle screw, and an adjustable rod having an outer housing coupled to one of the first pedicle screw and the second pedicle screw, the outer housing having a threaded shaft secured to one end thereof extending along an interior portion thereof. The system farther includes a hollow magnetic assembly disposed within the outer housing and having a magnetic element disposed therein, the hollow magnetic assembly having an internal threaded surface engaged with the threaded shaft, the magnetic assembly being coupled to the other of the first pedicle screw and the second pedicle screw, wherein the hollow magnetic assembly rotates in response to an externally applied magnetic field to thereby lengthen or shorten the distance between the first pedicle screw and the second pedicle screw.

RELATED APPLICATIONS

The present application is a divisional of U.S. patent application Ser.No. 16/297,257, filed Mar. 8, 2019, which is a continuation of U.S.patent application Ser. No. 14/449,761, filed Aug. 1, 2014 (now U.S.Pat. No. 10,265,101, issued Apr. 23, 2019), which is a continuation ofU.S. patent application Ser. No. 14/301,238, filed Jun. 10, 2014 (nowU.S. Pat. No. 10,349,982, issued Jul. 16, 2019), which is a continuationof U.S. patent application Ser. No. 14/355,202, filed Apr. 29, 2014 (nowU.S. Pat. No. 10,016,220, issued Jul. 10, 2018), which is a US nationalstage entry under 35 USC 371 of international patent application no.PCT/US2012/062696, filed Oct. 31, 2012, which claims the benefit of U.S.provisional patent application No. 61/567,936, filed Dec. 07, 2011 andU.S. provisional application No. 61/554,389, filed Nov. 01, 2011. Anyand all applications for which a foreign or domestic priority claim isidentified above and/or in the Application Data Sheet as filed with thepresent application are hereby incorporated by reference under 37 CFR1.57.

FIELD OF THE INVENTION

The field of the invention generally relates to medical devices fortreating spinal conditions.

BACKGROUND OF THE INVENTION

Degenerative disc disease affects 65 million Americans. Up to 85% of thepopulation over the age of 50 will suffer from back pain each year.Degenerative disc disease (DDD) is part of the natural process ofgrowing older. Unfortunately as we age, our intervertebral discs losetheir flexibility, elasticity, and shock absorbing characteristics. Theligaments that surround the disc, called the annulus fibrosis, becomebrittle and they are more easily torn. At the same time, the softgel-like center of the disc, called the nucleus pulposus, starts to dryout and shrink. The combination of damage to the intervertebral discs,the development of bone spurs, and a gradual thickening of the ligamentsthat support the spine can all contribute to degenerative arthritis ofthe lumbar spine.

When degenerative disc disease becomes painful or symptomatic, it cancause several different symptoms, including back pain, leg pain, andweakness that are due to compression of the nerve roots. These symptomsare caused by the fact that worn out discs are a source of pain becausethey do not function as well as they once did, and as they shrink, thespace available for the nerve roots also shrinks. As the discs betweenthe intervertebral bodies start to wear out, the entire lumbar spinebecomes less flexible. As a result, people complain of back pain andstiffness, especially towards the end of the day.

Depending on the severity and the condition, there are many ways totreat DDD patients, with fusion being the most common surgical option.The estimated number of thoracolumbar fixation procedures in 2009 was250,000. Surgery for degenerative disc disease usually involves removingthe damaged disc. In some cases, the bone is then permanently joined orfused to protect the spinal cord. There are many different techniquesand approaches to a fusion procedure. Some of the most common are ALIFs,PL1Fs, TLIFs, XLIFs (lateral), etc. Almost all of these techniques nowinvolve some sort of interbody fusion device supplemented with posteriorfixation (i.e., 360 fusion).

Another spinal malady that commonly affects patients is stenosis of thespine. Stenosis is related to the degeneration of the spine andtypically presents itself in later life. Spinal stenosis can occur in avariety of ways in the spine. Most of the cases of stenosis occur in thelumbar region (i.e., lower back) of the spine, although stenosis is alsocommon in the cervical region of the spine. Central stenosis is achoking of the central canal that compresses the nerve tissue within thespinal canal. Lateral stenosis occurs due to the trapping or compressionof nerves after it has left the spinal canal. This can be caused by bonyspur protrusions, bulging, or herniated discs.

SUMMARY OF THE INVENTION

In one embodiment, a system includes a first pedicle screw, a secondpedicle screw, and an adjustable rod having an outer housing coupled toone of the first pedicle screw and the second pedicle screw, the outerhousing having a threaded shaft secured to one end thereof extendingalong an interior portion thereof The system further includes a hollowmagnetic assembly disposed within the outer housing and having amagnetic element disposed therein, the hollow magnetic assembly havingan internal threaded surface engaged with the threaded shaft, themagnetic assembly being coupled to the other of the first pedicle screwand the second pedicle screw, wherein the hollow magnetic assemblyrotates in response to an externally applied magnetic field to therebylengthen or shorten the distance between the first pedicle screw and thesecond pedicle screw.

In another embodiment, a method for adjusting the amount of compressionbetween two vertebral bodies includes securing a first pedicle screw toa first vertebra, securing a second pedicle screw to a second vertebra,and securing an adjustable rod between the first pedicle screw and thesecond pedicle screw, the adjustable rod having an outer housing coupledto the first pedicle screw, the outer housing having a threaded shaftsecured to one end thereof extending along an interior portion thereof,the adjustable rod further having a hollow magnetic assembly disposedwithin the outer housing and having a magnetic element disposed therein,the hollow magnetic assembly having an internal threaded surface engagedwith the threaded shaft, the magnetic assembly being coupled to thesecond pedicle screw. The method further includes applying an externalmagnetic field to the adjustable rod to rotate the magnetic element.

In another embodiment, a system includes a first pedicle screw having ashank and a head, a second pedicle screw having a shank and a head, anda rod placed between the first pedicle screw and the second pediclescrew and contained within a housing. The system further includes amagnetic actuator disposed within the housing and associated with one ofthe first and second pedicle screws, the magnetic actuator having arotatable magnetic clement coupled to a bushing, the rotatable magneticclement configured to move relative to the housing in response to anexternally applied magnetic field, wherein movement in a first directionfrictionally engages the rod between the pedicle screw head and thebushing and wherein movement in a second direction disengages the rodfrom the pedicle screw head and the bushing.

In another embodiment, a system includes a first pedicle screw, a secondpedicle screw, and a flexible spacer configured for placement betweenthe first and second pedicle screws, the flexible spacer configured toadjust a compression or tension force between the first pedicle screwand second pedicle screw in response to an externally applied magneticfield.

In another embodiment, a device includes an interbody screw having firstand second portions, the first portion having a threaded end and thesecond portion having a threaded end, at least one of the first andsecond portions being axially moveable with respect to the other inresponse to an externally applied magnetic field.

In another embodiment, an artificial disc device includes a bodyportion, a first adjustable member, and a second adjustable memberarranged generally orthogonal to the first adjustable member, where thefirst and second adjustable members are configured to adjust a COR ofthe body portion in two orthogonal dimensions in response to anexternally applied magnetic field.

In another embodiment, a distraction device interposed between twovertebral bodies includes first and second portions, one of the portionsincluding a permanent magnet configured to rotate in response to anexternally applied non-invasive magnetic field, the permanent magnetoperatively coupled to a screw whereby rotation in one directionincreases the height between the first and second portions.

In another embodiment, a distraction device implanted in a singlevertebral body includes first and second portions, one of the portionsincluding a permanent magnet configured to rotate in response to anexternally applied non-invasive magnetic field, the permanent magnetoperatively coupled to a screw whereby rotation in one directionincreases the width between the first and second portions.

In another embodiment, a method of adjusting the spinal canal includesforming first and second bores into a vertebral body, making pediclecuts to separate a portion of the vertebral body from the pedicles, andsecuring first and second distraction devices within the first andsecond bores. The method further includes applying a non-invasivemagnetic field to the first and second distraction devices to expand thespinal canal.

In another embodiment, a system for adjusting the spinal canal includesa drilling tool for drilling first and second bores into a vertebralbody, a cutting tool for making first and second pedicle cuts toseparate a portion of the vertebral body from associated pedicles, andfirst and second distraction devices configured for placement within thefirst and second bores. The system further includes an externaladjustment device configured to apply a non-invasive magnetic field tothe first and second distraction devices, whereby the non-invasivemagnetic field distracts both the first and second distraction devices.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A illustrates one embodiment of a pedicle screw system for fusion.

FIG. 1B illustrates a sectional view of a pedicle screw of the pediclescrew system of FIG. 1A.

FIG. 2A illustrates another embodiment of a pedicle screw system forfusion applications.

FIG. 2B illustrates a sectional view of the pedicle screw system of FIG.2A.

FIG. 3 illustrates another embodiment of a dynamic rod embodiment.

FIG. 4A illustrates a screw.

FIG. 4B illustrates an interbody device according to another embodiment.

FIG. 5 illustrates an artificial disc embodiment.

FIG. 6 illustrates one embodiment of a distraction device used forvertebral body height adjustment.

FIG. 7 illustrates a top view of one embodiment of a distraction deviceused for vertebral body width adjustment.

FIG. 8 illustrates a side view of the embodiment of FIG. 7.

FIG. 9 illustrates an embodiment of a system that includes multipledistraction devices for the selective and incremental expansion of thespinal column.

FIG. 10 illustrates an embodiment of one type of distraction device.

FIG. 11 illustrates an embodiment of another type of distraction device.

FIG. 12 illustrates an embodiment of another type of distraction device.Two of these devices are illustrated in the system of FIG. 9.

FIG. 13 illustrates a perspective view of an external adjustment device.

FIG. 14 illustrates an exploded view of the magnetic handpiece of theexternal adjustment device of FIG. 13.

FIG. 15 illustrates a first orientation of two magnets of the externaladjustment device in relation to an implanted magnet.

FIG. 16 illustrates a second orientation of the two magnets of theexternal adjustment device in relation to the implanted magnet.

DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

FIG. 1A illustrates a side view of a pedicle screw-based system 2 forthe stabilization of the spine during fusion. The device includes afirst pedicle screw 10 disposed in a first vertebral body 11, a secondpedicle screw 12 disposed in a second vertebral body 13, and a rod 14located between the first pedicle screw 10 and the second pedicle screw12. The rod 14 is fixedly secured at one end to the first pedicle screw10. The opposing end of the rod 14 is selectively coupled/de-coupled tothe second pedicle screw 12 using a magnetic actuator 16, seen in moredetail in FIG. 1B. The second pedicle screw 12 includes a screw body 15having a shank 17 and a spherical head 18. Spherical head 18 has acontact surface 19 which serves as a point of contact when the secondpedicle screw 12 is coupled to the rod 14. As seen in FIG. 1B, thesystem 2 includes a housing 21 having an end or lip 23 for engaging withthe spherical head 18 of the screw body 15 and maintaining the screwbody 15 in a particular orientation in relation to the housing 21 whenthe second pedicle screw 12 is coupled to the rod 14. The system 2includes a magnetic element 28 having a radially-poled magnet 27 bondedwithin the magnetic element 28. One end of the magnetic element 28 has acoupler 31 which fits into a cavity 29 of a bushing 25. The bushing 25has a saddle-shaped surface 46 that is shaped to engage with a sidesurface of the rod 14. The magnetic element 28 can rotate freely withrespect to the bushing 25, but the coupler 31 transfers axial movementof the magnetic clement 28 to axial movement of the bushing 25 when thecoupler 31 makes contact with the bushing 25 inside the cavity 29. Themagnetic element 28 includes male threads 33 that engage withcorresponding female threads 35 located within an inner surface of thehousing 21. As seen in FIG. 1B, the magnetic actuator actuates in adirection that is generally perpendicular to the axis of the rod 14. Inthis manner, the rod 14 is pinched between the bushing 25 and the head18 of the pedicle screw 12.

The magnetic actuator 16 can be selectively mechanically engaged ordisengaged to the second pedicle screw 12 using an externally appliedmoving magnetic field. For example, one or more rotating or cyclingmagnets disposed outside the body can be used to selectively engage ordisengage the rod 14 to the second pedicle screw 12 by pinching the rod14 between the bushing 25 and the contact surface 19 of the sphericalhead 18 of the second pedicle screw 12. The radially-poled magnet 27 maybe made from a rare earth magnet, for example, Neodymium-Iron-Boron.Because the radially-poled magnet 27 and, thus, magnetic element 28 arenon-invasively rotated by the moving magnetic field, the bushing 25 ismoved axially to frictionally grip the rod 14 between the contactsurface 19 of the spherical head 18 and the bushing 25. A cap 37 havingfemale threads 41 is screwed over male threads 43 of the housing 21 toprotect the inner contents. As seen in FIG. 1B, an O-ring seal 39 sealsthe cap 37 to the housing 21. For example, after a fusion procedure hasbeen performed to fuse vertebral bodies 11, 13 together, the subjectundergoes radiographic imaging. At this point, the second pedicle screw12 is engaged with the rod 14. Once evidence of anterior fusion is seen,an external magnetic field is applied (e.g., rotating magnetic field) todisengage or de-couple the second pedicle screw 12 from the rod 14. Thepedicle screws 10, 12 are no longer providing support and allowposterior movement. This will prevent stress shielding and reducestresses on adjacent levels. Stress shielding refers to the reduction inbone density (osteopenia) as a result of removal of normal stress fromthe bone by an implant (for instance, the femoral component of a hipprosthesis). This is because by Wolff's law, bone in a healthy person oranimal will remodel in response to the loads it is placed under.Therefore, if the loading on a bone decreases, the bone will become lessdense and weaker because there is no stimulus for continued remodelingthat is required to maintain bone mass.

This technology could be utilized to “decouple” the rod/screw interfaceto minimize or eliminate the stress shielding post fusion. Thisdecoupling could provide the same benefit as surgical removal butwithout the need for a reoperation to remove the hardware post fusion.The stress shielding of the fused level may also contribute to adjacentlevel disease. If the screws/rods were decoupled, there is thepossibility that the fused level would induce less stress on theadjacent level and minimize adjacent level disease. Once disengaged, anexternal magnetic field may be applied again to once again engage thesecond pedicle screw 12 to the rod 14, locking in a new configurationwith a lower stress.

Alternatively, the device may be implanted into two vertebral bodies 10,12 that have not been fused. This embodiment provides support andpossible height restoration while the injured and/or diseased spinalsegment heals. As healing occurs, the same or similar device can be usedto introduce motion back to the spinal segment in the manner of aninternal brace. If pain recurs, the surgeon can re-tighten pediclescrews to support the spine again. Initial implantation of the pediclescrews/rods can be set either rigid or flexible. The flexibility isadjusted post-operatively either increased or decreased based on thepatient healing and pain levels.

FIGS. 2A and 2B illustrate another system 20 to control the loading ofan interbody fusion to better promote fusion. Traditional pedicle screwsmay offload discs substantially. There is a general consensus in themedical community that fusion requires some degree of compression tofully form. The system 20 described herein includes two pedicle screws22, 24 that are connected together via an adjustable rod 26. Theadjustable rod 26 is able to shorten (direction of facing arrows A) toapply a compressive load to the vertebral bodies to aid in fusion. Theadjustable rod 26 may also be lengthened to reduce this compressiveload. The system 20 may be adjusted repeatedly to apply multipleapplications of a compressive load to the vertebral bodies if needed.For this system 20, interbody and pedicle screw fixation are conductedas normal, however, the two pedicle screws 22, 24 are interconnected toone another via the adjustable rod 26. The adjustable rod 26 includes anouter housing 55 that is secured to the pedicle screw 22 and includes athreaded shaft 53 that is fixedly secured to one end thereof and extendsinwardly within the outer housing 55. The adjustable rod 26 furtherincludes a hollow magnetic assembly 69 that is disposed within the outerhousing 55 and includes a hollow magnetic element 45 disposed therein,the hollow magnetic assembly 69 having an internal threaded surface 51engaged with external threads 73 of the threaded shaft 53, the magneticassembly 69 being coupled to the other of the first pedicle screw andthe second pedicle screw.

The hollow magnetic element 45 is preferably a radially-poled hollowmagnet and effectuates rotation of the hollow magnetic assembly 69 that,for example, rotates in response to an externally applied movingmagnetic field. The hollow magnetic assembly 69 may be formed by thehollow magnetic clement 45 contained on or within a rotatable cylinder47. The rotatable cylinder 47 has a hollow cavity 49 into or on which isbonded a nut 71 that contains the threaded surface 51. The nut 71includes internal threads 51 that engage with a correspondingly threadedshaft 53 which is fixedly attached to the outer housing 55, for example,at weld joint 57. The outer diameter of the rotatable cylinder 47 mayinclude an optional O-ring 59, which seals to the inner diameter of theouter housing 55. The rotatable cylinder 47 is longitudinally locked tothe inner shaft 61 via a rotational coupling or swivel 63. A firstpedicle screw 22 is attached to the outer housing 55 and a secondpedicle screw 24 is attached to the inner shaft 61 during surgery. Theinner shaft 61 is telescopically adjustable within the outer housing 55.The rotation of the radially-poled hollow magnetic element 45 containedin or on the rotatable cylinder 47 of the adjustable rod 26 is thentranslated into axial shortening or lengthening of the adjustable rod26. A thrust bearing 65 is held between inner shaft 61 and rotatablecylinder 47, and supports the axial load if the adjustable rod 26 isadjusted in compression (applying distraction between vertebral bodies).An externally applied magnetic field may be applied using an externaladjustment device of the type described herein.

Once implanted in the subject, if radiographic evidence of non-fusion orpseudo-fusion exists, then the surgeon can adjust the pressure on thefusion site by shortening the adjustable rod 26 and thereby moving thepedicle screws 22, 24 closer to one another to apply a compressive forcebetween the vertebral bodies. The amount of shortening of the adjustablerod 26 will vary the degree of compression applied to the vertebralbodies. An alternative manner of assessing the degree of fusion is bysupplying a strain gauge or other force measurement sensor on theadjustable rod, and non-invasively assessing the level of this forceover time.

FIG. 3 illustrates another embodiment of a system 30 that includes twopedicle screws 32, 34 and a flexible body or spacer 36 that separatesthe two pedicle screws 32, 34. The flexible spacer 36 has at one end amagnetic element 38 that interfaces with a cord or rod 40 that extendswithin the flexible spacer 36. Movement of the magnetic element 38(e.g., rotation) in response to an applied external magnetic field setsthe tensions of the cord or rod 40 and pedicle screws 32, 34. Thus, thetension of the cord or rod 40 as well as the flexible spacer 36 can becontrolled in a non-invasive manner. The tension on the cord or rod 40may be adjusted by the externally applied magnetic field, in order tolimit or delimit the amount of motion.

FIG. 4B illustrates another embodiment of a system 50 that includes anadjustable screw 52 with threads on opposing ends much in the manner ofa Herbert screw (FIG. 4A). The pitch of each threaded end is differentfrom each other. In this embodiment, as seen in FIG. 4B, a singleadjustable screw 52 includes a moveable segment or portion 54 that movesaxially relative to a second segment or portion 56. An internal magnet58 disposed in the adjustable screw 52 rotates in response to an appliedexternal magnetic field thereby causing axial movement of the moveablesegment 54 relative to the other portion 56. For example, the adjustablescrew 52 can increase in length (arrow B), thereby creating distractionbetween vertebral bodies. The degree of distraction (or compression) canbe altered as needed. This system 50 may be used in conjunction withfusion applications where adjustment is needed to apply compression orother forces to the fused vertebra. This is also useful in two levelprocedures to adjust one or both levels as this is very difficult tocontrol using current devices and methods.

FIG. 5 illustrates another embodiment of an artificial disc 60 that isadjustable in two directions. A significant effort has gone on into thedevelopment of artificial discs. A key design feature of almost allartificial discs is to mimic the natural motion of the spine. A criticalfeature of artificial discs is the center of rotation (COR) and where itis located. While much work has gone into precisely calculating the CORof implants, in practice, trying to place the artificial disc and liningup the COR is nearly impossible. Quite often the surgeon has missedplacement, either lateral/medial and/or anterior/posterior. Thismisplacement is very difficult or impossible to correct.

There is a need post-implantation of an artificial disc to adjust theCOR. FIG. 5 illustrates one such artificial disc 60 that includes an x-yadjustment feature built therein. The adjustment feature includes twoorthogonal adjustment members 62, 64 that are able to move the body ofthe artificial disc 60 in the x and y directions. The adjustment membersmay lengthen or shorten based on a rotational magnet 66 contained ineach adjustment member. Application of an external magnetic field isable to adjust each adjustment member. Preferably, each adjustmentmember can be independently adjusted by a single external adjustmentdevice.

Ideally, the adjustment would be done with the aid of a fluoroscope. Themedial to lateral positioning is relatively straight forward and can bedone while the patient is in a standing position. For the A/Ppositioning, the patient could go through flexion and extension motionand the surgeon can monitor the movement of the vertebra relative to thedisc and adjust accordingly. This would ensure ideal alignment of theCOR of the implant.

FIG. 6 illustrates a distraction device 302 configured for distractionbetween a first vertebral body 400 and a second vertebral body 402.Intervertebral disks can degenerate, bulge, herniate or thin, and causeaccompanying back pain. In this embodiment, the distraction device 302is inserted between adjacent vertebral bodies 400, 402 and using anexternal adjustment device (described below) is used to adjust theheight of the distraction device 302 to the desired level. Thisdistraction device 302 can distract the vertebral body (e.g., vertebralbody 400) to the correct height. Subsidence is a common problemresulting in the loss of disc height over time. After implantation, thedistraction device 302 can be adjusted post-operatively using anexternal adjustment device to restore disc height. The adjustments maybe performed intermittently or periodically as required. The adjustmentsare preferably made after implantation but prior to complete fusion ofthe affected vertebral bodies.

The distraction device 302 contains a first portion 307 and a secondportion 309 and an internal, permanent magnet 304 that can be rotated inresponse to an applied external magnetic field via an externaladjustment device 180 as seen in FIGS. 13 and 14. internal magnet 304 iscoupled to lead screw 306 so that rotation motion changes thedisplacement between lead screw 306 and the female thread 308 inside thefirst portion 307 of the distraction device 302 (although theconfiguration could be reversed). Rotation of the lead screw 306 in onedirection causes the first portion 307 and the second portion 309 toseparate from one another, thereby increasing the height between thesame and the attached vertebral bodies 400, 402. Rotation of the leadscrew 306 in the opposite direction causes the first portion 307 and thesecond portion 309 to move closer together, thereby decreasing theheight between the same and the attached vertebral bodies 400, 402.

FIGS. 7 and 8 illustrate another embodiment of a distraction device 310.This embodiment of the distraction device 310 is used for widthadjustment. A wider interbody device provides better clinical results byproviding additional stability and minimizing subsidence issues. In thisembodiment, the distraction device 310 has a fixed height but can bedistracted using an external adjustment device 180 like that seen inFIGS. 13 and 14 to provide a variable width. The distraction device 310of FIGS. 7 and 8 is oriented between a first vertebral body 400 and asecond vertebral body 402, as best seen in FIG. 8, and is generallyperpendicular with the orientation of the device 302 of FIG. 6.Distraction of the device 310 will expand the width between thevertebral bodies 400, 102. Like the prior embodiment, there is a firstportion 311 and a second portion 313 and an internal, permanent magnet312 that can be rotated in response to an applied external magneticfield via an external adjustment device 180. The internal magnet 312 iscoupled to a lead screw 314 so that rotational motion changesdisplacement between lead screw 314 and a female thread 316 locatedinside the first portion 311 of the distraction device 310. Thedistraction device 310 has a fixed height which provides for a smallinterbody implant to be inserted. However, the adjustability of thewidth of the distraction device 310 and the vertebral bodies 400, 402containing the same provides for increased stability. Also illustratedare pedicles 336, 338 and the spinal canal 410. The distraction device310 generally distracts in a direction that is substantiallyperpendicular to the longitudinal axis of the spinal canal 410.

FIG. 9 illustrates another embodiment of a system 330 that includesmultiple distraction devices 332 for the selective and incrementalexpansion of the spinal canal 410. In this embodiment, two distractiondevices 332 are located within respective bores 334 formed in eachpedicle 336, 338 of a single vertebral body 400. The bores 334 may beformed using conventional drilling tools and techniques. After the bores334 have been formed, circumferential pedicle cuts 340 are made in eachpedicle 336, 338 (i.e., osteotomy). The circumferential pedicle cuts 340are made by a rotating cutting tool such as a burr (not shown) that isplaced within each bore 334. The circumferential pedicle cuts 340, oncemade, completely separate a portion of the vertebral body 400 from therespective pedicles 336, 338. The two distraction devices 332 aresecured within the respective bores 334. The distraction devices 332 maybe secured using an adhesive, cement, threads that engage bone tissue orfasteners (e.g., screws or the like).

Utilizing the Ilizarov technique of bone lengthening, only a small gapin each pedicle 336, 338 is left after installation of the distractiondevices 332. As the cut pedicles 336, 338 begin to grow back together,each distraction device 332 is expanded incrementally at a rate ofapproximately one (1) millimeter per day. Each incremental expansion ofthe distraction devices 332 progressively opens up the spinal canal 410.This is accomplished using the external adjustment device 180 describedherein. The adjustments are performed while the subject is awake toprovide feedback regarding symptom relief. For example, afteradjustment, the subject may move his or her spine through one or moremotions to determine the degree to which expansion of the spinal canal410 has reduced discomfort or pain. Additional adjustments of thedistraction devices 332 may be made daily or periodically until thespinal canal 410 has been opened up enough to provide the subject withthe desired amount of pain or discomfort relief. As part of the periodicadjustment, the subject may go through one or more range of motions togive direct feedback on pain and discomfort levels. Once the desiredendpoint has been reached, additional adjustments can be stopped, atwhich point the cut pedicles 336, 338 will undergo a period ofconsolidation and fully form into a solid bone mass. FIG. 9 illustratesdistraction devices 332 of the type illustrated in FIG. 12 securedwithin bores 34, although other distraction devices 332 may be used inconnection with the procedure.

FIG. 10 illustrates one embodiment of a distraction device 332 thatincludes a moveable segment or portion 342 that moves axially relativeto a second segment or portion 344. An axially-poled internal magnet 346disposed in the distraction device 332 rotates in response to an appliedexternal magnetic field thereby causing axial movement of the moveablesegment 342 relative to the other portion 344. The moveable segment 342contains threads 343 on a portion thereof that interface withcorresponding threads 345 disposed on the second portion 344. Rotationof the moveable segment 42 relative to the second portion 44 results inaxial displacement of the distraction device 332. For example, thedistraction device 332 can increase in length (arrow B), therebycreating a distraction force. The degree of distraction (or compression)can be altered as needed. Threads 348, 350 arc located at the respectiveends of the moveable segment 342 and the second portion 344 which can beused to engage bone tissue.

FIG. 11 illustrates another embodiment of a distraction device 332. Thedistraction device 332 includes first and second portions 352, 354 thatinclude respective recesses 356, 358 that contain a rotatable,axially-poled permanent magnet 360. The permanent magnet 360 is coupledto or may include a threaded portion 362 that engages with correspondingthreads 364 in one of the first and second portions 352, 354. Rotationof the rotatable permanent magnet 360 extends the first and secondportions 352, 354 away from one another, thereby increasing thedistraction force. As seen in FIG. 11, the ends of the first and secondportions 352, 354 may include threads 366, 368 which can be used toengage bone tissue within each bore 334.

FIG. 12 illustrates another embodiment of a distraction device 332. Thedistraction device 332 includes first and second portions 370, 372 eachhaving respective threads 374, 376 at an end thereof for mounting thedistraction device 332 within each bore 334 as described above. Thefirst and second portions 370, 372 include respective recesses 378, 380that contain a rotatable permanent magnet 382. The permanent magnet 382is coupled to or may include two threaded portions 384, 386 that engagewith corresponding threads 388, 390 in the first and second portions370, 372. In the embodiment of FIG. 12, the distraction device 332includes one or more guides 394 that extend between the first and secondportions 370, 372. The guides 394 prevent relative rotation between thefirst and second portions 370, 372 yet still permit elongation of thedistraction device 332. For example, a plurality of guides 394 could belocated circumferentially about the first and second portions 370, 372to prevent relative rotation.

FIG. 13 illustrates an external adjustment device 180 which is used tonon-invasively adjust the devices and systems described herein. Theexternal adjustment device 180 includes a magnetic handpiece 178, acontrol box 176 and a power supply 174. The control box 176 includes acontrol panel 182 having one or more controls (buttons, switches ortactile, motion, audio or light sensors) and a display 184. The display184 may be visual, auditory, tactile, the like or some combination ofthe aforementioned features. The external adjustment device 180 maycontain software which allows programming by the physician.

FIG. 14 shows the detail of the magnetic handpiece 178 of the externaladjustment device 180. As seen in FIG. 14, there are two (2) magnets 186that have a cylindrical shape. The magnets 186 are made from rare earthmagnets. The magnets 186 are bonded or otherwise secured within magneticcups 187. The magnetic cups 187 include a shaft 198 which is attached toa first magnet gear 212 and a second magnet gear 214, respectively. Theorientation of the poles of each the two magnets 186 are maintained inrelation to each other by means of the gearing system (by use of centergear 210, which meshes with both first magnet gear 212 and second magnetgear 214).

The components of the magnetic handpiece 178 are held together between amagnet plate 190 and a front plate 192. Most of the components areprotected by a cover 216. The magnets 186 rotate within a static magnetcover 188, so that the magnetic handpiece 178 may be rested directly onthe patient, while not imparting any motion to the external surfaces ofthe patient Prior to distracting the intramedullary lengthening device110, the operator places the magnetic handpiece 178 over the patientnear the location of the cylindrical magnet 134. A magnet standoff 194that is interposed between the two magnets 186 contains a viewing window196 to aid in the placement. For instance, a mark made on the patient'sskin at the appropriate location with an indelible marker may be viewedthrough the viewing window 196. To perform a distraction, the operatorholds the magnetic handpiece 178 by its handles 200 and depresses adistract switch 228, causing motor 202 to drive in a first direction.The motor 202 has a gear box 206 which causes the rotational speed of anoutput gear 204 to be different from the rotational speed of the motor202 (for example, a slower speed). The output gear 204 then turns areduction gear 208 which meshes with center gear 210, causing it to turnat a different rotational speed than the reduction gear 208. The centergear 210 meshes with both the first magnet gear 212 and the secondmagnet gear 214 turning them at a rate which is identical to each other.Depending on the portion of the body where the magnets 186 of theexternal adjustment device 180 arc located, it is desired that this ratebe controlled, to minimize the resulting induced current densityimparted by magnet 186 and cylindrical magnet 134 though the tissues andfluids of the body. For example, a magnet rotational speed of 60 RPM orless is contemplated although other speeds may be used, such as 35 RPMor less. At any time, the distraction may be lessened by depressing theretract switch 230. For example, if the patient feels significant pain,or numbness in the area holding the device.

FIGS. 15 and 16 illustrate the progression of the magnets 186(individually numbered 1134 and 1136) and the implanted magnet 1064 thatis located within the distraction device during use. Implanted magnet1064 is shown for illustration purposes. Implanted magnet 1064 is onepossible embodiment of the magnetic element described herein. FIGS. 15and 16 illustrate the external adjustment device 180 being disposedagainst the external surface of the patient's skin 1180 adjacent thespine. In the non-invasive adjustment procedure depicted, the patient100 lies in a prone position, and the external adjustment device 180 isplaced upon the patient's back. However, the adjustment is conceivedpossible with the patient in supine or standing positions. The externaladjustment device 180 is placed against the skin 1180 in this manner toremotely rotate the implanted magnet 1064. As explained herein, rotationof the implanted magnet 1064 is translated into linear motion tocontrollably adjust the distraction device.

As seen in FIGS. 15 and 16, the external adjustment device 180 may bepressed down on the patient's skin 1180 with some degree of force suchthat skin 1180 and other tissue, such as the underlying layer of fat1182, are pressed or forced into the recess 1174 of the externaladjustment device 180. FIGS. 15 and 16 show the magnetic orientation ofthe implanted magnet 1064 as it rotates in response to rotation of thepermanent magnets 1134, 1136 of the external adjustment device 180.

With reference to FIG. 15, the implanted magnet 1064 is shown beingoriented with respect to the two permanent magnets 1134, 1136 via anangle 0. This angle 0 may depend on a number of factors including, forinstance, the separation distance between the two permanent magnets1134, 1136, the location or depth of where the implanted magnet 1064 islocated, the degree of force at which the external adjustment device 180is pushed against the patient's skin. Generally, in applicationsincluding some obese patients, the angle θ should be at or around 90° toachieve maximum drivability (e.g., torque).

FIG. 15 illustrates the initial position of the two permanent magnets1134, 1136 and the implanted magnet 1064. This represents the initial orstarting location (e.g., 0° position as indicated). Of course, it shouldbe understood that, during actual use, the particular orientation of thetwo permanent magnets 1134, 1136 and the implanted magnet 1064 will varyand likely will not have the starting orientation as illustrated in FIG.15. In the starting location illustrated in FIG. 15, the two permanentmagnets 1134, 1136 are oriented with their poles in an N-S/S-Narrangement. The implanted magnet 1064 is, however, oriented generallyperpendicular to the poles of the two permanent magnets 1134, 1136.

FIG. 16 illustrates the orientation of the two permanent magnets 1134,1136 and the implanted magnet 1064 after the two permanent magnets 1134,1136 have rotated through 90° . The two permanent magnets 1134, 1136rotate in the direction of arrow A (e.g., clockwise) while the implantedmagnet 1064 rotates in the opposite direction (e.g., counter clockwise)represented by arrow B. It should be understood that the two permanentmagnets 1134, 1136 may rotate in the counter clockwise direction whilethe implanted magnet 1064 may rotate in the clockwise direction.

During operation of the external adjustment device 180, the permanentmagnets 1134, 1136 may be driven to rotate the implanted magnet 1064through one or more full rotations in either direction to increase ordecrease distraction of the device as needed. Of course, the permanentmagnets 1134, 1136 may be driven to rotate the implanted magnet 1064through a partial rotation as well (e.g., ¼, ⅛, 1/16, etc.). The use oftwo magnets 1134, 1136 is preferred over a single external magnetbecause the implanted magnet 1064 may not be oriented perfectly at thestart of rotation, so one external magnet 1134, 1136 may not be able todeliver its maximum torque, which depends on the orientation of theinternal driven magnet 1064 to some degree. However, when two (2)external magnets (1134, 1136) are used, one of the two, 1134 or 1136,will have an orientation relative to the internal driven magnet 1064that is better or more optimal than the other. In addition, the torquesimparted by each external magnet 1134, 1136 are additive.

While embodiments of the present invention have been shown anddescribed, various modifications may be made without departing from thescope of the present invention. As one example, the devices describedherein may be used to lengthen or reform a number of other bones such asthe mandible or the cranium. The invention, therefore, should not belimited, except to the following claims, and their equivalents.

What is claimed is:
 1. A system comprising: a first pedicle screw; asecond pedicle screw separated from the first pedicle screw by adistance; and an adjustable rod further comprising an outer housing, theouter housing having a threaded shaft secured to one end thereof andextending along an interior portion thereof; an inner shaft, at least aportion of the inner shaft telescopically adjustable within the outerhousing; and a hollow magnetic assembly comprising a hollow magneticelement disposed around at least a portion of the threaded shaft, thehollow magnetic assembly having an internal threaded surface engagedwith the threaded shaft, with the hollow magnetic assembly rotatablycoupled to the second pedicle screw by a rotational coupling; whereinthe hollow magnetic assembly is configured to rotate in response to anexternally applied magnetic field and is configured to increase ordecrease the distance between the first pedicle screw and the secondpedicle screw.
 2. The system of claim 1, wherein the hollow magneticassembly comprises a hollow cylindrical radially-poled magnet.
 3. Thesystem of claim 2, wherein the hollow cylindrical radially-poled magnetcomprises a rare earth magnet.
 4. The system of claim 1, furthercomprising a thrust bearing disposed between the magnetic assembly andthe second pedicle screw.
 5. The system of claim 2, wherein the internalthreaded surface of the hollow magnetic assembly comprises a nut coupledto an internal surface of the hollow magnetic assembly.
 6. The system ofclaim 1, further comprising an external adjustment device configured toapply a rotating magnetic field.
 7. A system comprising: a first pediclescrew; a second pedicle screw; an adjustable rod comprising: an outerhousing coupled to the first pedicle screw, the outer housing having athreaded shaft extending along an interior portion thereof; an innershaft coupled to the second pedicle screw, at least a portion of theinner shaft telescopically adjustable within the outer housing; a hollowmagnetic assembly comprising a hollow magnetic element disposed therein,the hollow magnetic element disposed around at least a portion of thethreaded shaft, the hollow magnetic assembly having an internal threadedsurface configured to engage the threaded shaft, the hollow magneticassembly being rotatably coupled to the second pedicle screw by arotational coupling; and a thrust bearing disposed between the magneticassembly and the second pedicle screw; and wherein the hollow magneticassembly rotates in response to an externally applied magnetic field tothereby lengthen or shorten a distance between the first pedicle screwand the second pedicle screw.
 8. The system of claim 7, wherein theinternal threaded surface of the hollow magnetic assembly comprises anut coupled to an internal surface of the hollow magnetic assembly. 9.The system of claim 7, wherein the external magnetic field comprises arotating magnetic field.